Emergency general surgery admission proformas: The value of repeated audit to deliver sustained improvements

Abstract

s / International Journal of Surgery 12 (2014) S13eS117 S95 1097: EMERGENCY GENERAL SURGERY ADMISSION PROFORMAS: THE VALUE OF REPEATED AUDIT TO DELIVER SUSTAINED IMPROVEMENTS Sarah Wheatstone , Brenda Stacey, Kothandaraman Murali. Darent Valley Hospital, Dartford, Kent, UK. Introduction: Clear, accurate and legible medical records are essential elements of good medical practice and prevent medical errors. The assessment and prescription of venous thrombosis (VTE) prophylaxis is a CQUIN target. We reviewed documentation standards before and after introduction of a dedicated emergency general surgery admissions proforma. After further adjustments we twice re-audited improved proformas. Methods: We audited 50 consecutive emergency admission case notes at four different times: April 2011, October 2011, November 2012 and January 2014. Notes were inspected for patient demographics, team contact details, clinical documentation and management plans. Drug charts and handover sheets were also reviewed. Inpatient referrals were excluded. Results: At final audit, significant improvements were found for patient identifying details (71%-100%, p<0.001), VTE risk assessment (2-86%, p<0.001), allergy documentation (87%-100%, p<0.01), and differential diagnosis (87-98%, p<0.05). There were sustained improvements in the recording of admitting doctor, investigations, and prescription of analgesia, anti-emetics and intra-venous fluids. Despite a prompt box, decision to operate and capacity assessment were rarely recorded. Conclusions: A printed proforma can prompt admitting surgeons to capture more information. Re-audit followed by proforma refinement and team education can improve results further. General surgical teams should be engaged in these changes in the documentation process. 1099: SOFTLY SPREADING? THE INCIDENCE OF SOFT TISSUE INFECTIONS IN AN IRISH REGIONAL HOSPITAL David Kennedy , Sarah Phelan, Helen Mohan, Caoimhe Byrne, Niamh Bambury, Ken Mealy. Wexford General Hospital, Co. Wexford, Ireland. Introduction: Soft-tissue infections are a major cause of morbidity and a burden on hospital resources. Internationally, their incidence is rising.1 The main aim of this study was to examine trends in soft-tissue infection at an Irish regional hospital. Methods: A retrospective analysis of a prospectively maintained surgical audit database (based on the Lothian surgical audit system) from January 2000 until December 2012 was performed. Information collected included baseline demographics, number of admissions, length of stay, and rates of surgical intervention. Statistical analysis was performed using Graph Pad Prism 6. Results: In total, therewere 1388 admissions for cellulitis from 2000-2012. Therewas a significant increase in themean number of admissions per year over the study period, with a 53.4% increase from 2000-2003 compared with 2009-2012 (p1⁄40.0286 Mann-Whitney U test). However, the mean length of stay remained unchanged (7.6 days versus 6.5 days, p1⁄4ns). Conclusions: The incidence of soft-tissue infections is rising. This has implications for planning delivery of acute surgical services. Potential approaches include community based care for a suitable subset, and a focus on primary prevention.[1] Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011 Oct; 46(10):1935-41. 1101: IS BILIRUBIN A USEFUL MARKER IN DIAGNOSING APPENDICITIS? Umar Sharif, David Mathews, Ahmed Karim , Michaela Janks, Hannah Boyd-Carson, Tiramula Raju. Heart of England Trust, Birmingham,